Demystifying assessment:The SJT

Jessica White

Why it is worth working for this exam

EPM 50 marks but everyone has 34

SJT 50 marks, so total worth is 50/66 = 75%

Level playing field for all FPAS applicants

Further reasons to practice questions

• Database had only 275 questions (2011)• Limited scenarios• Working through 200 + questions will ensure

you have been exposed to nearly all possible scenarios

Preparing for the SJT

• Don’t be anxious about it• On-line practice paperhttp://sjt.foundationprogramme.nhs.uk/ • Several resources – on-line and books• BMJ resource

http://learning.bmj.com/learning/module-intro/.html?locale=en_GB&moduleId=10036102

Further Resources

• GMC www.gmc-uk.org– Good Medical Practice (2012)– Tomorrow’s Doctors (2009) ‘outcomes 3 –the

doctor as a professional’• UK Foundation Programme

www.foundationprogramme.nhs.uk– Person Specification for recruitment to the

Foundation Programme– Foundation Programme Curriculum

Domains tested

1 Commitment to Professionalism2 Coping with pressure3 Effective communication4 Patient focus5 Working effectively as a team6 Learning and professional development7 Organisation and planning8 Problem solving and decision-making9 Self-awareness and insight

Example questions

Example SJT Questions

Two question formats:

• Rank the five responses in the most appropriate order• Choose the three most appropriate responses

from eight

Answer what you ‘should’ do as an FY1 in the scenario described, not what you ‘would’ do

3 from 8 questions marking

• Each correct answer worth 4 points• Maximum score 12 points• Giving more than 3 answers leads to zero

points

Ranking 5 answers markingMaximum mark 20, minimum 8Joint ranking of answers will give a zero score

Correct Order

1 2 3 4 5

1 4 3 2 1 0

2 3 4 3 2 1

3 2 3 4 3 2

4 1 2 3 4 3

5 0 1 2 3 4

Applicant order

The mark sheet

Commitment to professionalism

• Honest, trustworthy, reliable and aware of ethical issues such as confidentiality

• Should challenge behaviour that is unacceptable or risks patient safety

• Should take responsibility for their own actions and omissions

A patient on your ward is HIV positive. He is from a minority community which he feels might react negatively if they knew of his diagnosis. As a result he is very anxious that no one including his close family should be told.Rank responses in order of appropriateness

A. Eliminate all mention of HIV from his notesB. Amend your patient list so this detail is missing or obscured

(eg ‘retroviral illness’)C. Ensure the safety of other doctors and phlebotomists by

writing HIV +ve on blood requestsD. Tell patient he should talk to his family as you cannot

guarantee complete confidentialityE. Continue as you would for any other patient under your care

A patient on your ward is HIV positive. He is from a minority community which he feels might react negatively if they knew of his diagnosis. As a result he is very anxious that no one including his close family should be told.Rank responses in order of appropriateness

A. Eliminate all mention of HIV from his notesB. Amend your patient list so this detail is missing or obscured

(eg ‘retroviral illness’)C. Ensure the safety of other doctors and phlebotomists by

writing HIV +ve on blood requestsD. Tell patient he should talk to his family as you cannot

guarantee complete confidentialityE. Continue as you would for any other patient under your care

B, E, D, C, A

Coping with pressure

• Resilient and calm under pressure• Judgment should not be affected by pressure• Appropriate coping strategies needed

You are on call and bleeped by a ward nurse about a bag of blood which was mistakenly taken out of the fridge. As it cannot now be returned, she asks you to prescribe it for the patient so that is is not ‘wasted’. You are not intending to visit the ward for some time and the nurse sounds frustrated as the blood will be lost 30 mins after removal from the refrigerator.Rank in order of appropriate responses

A. Go to the ward immediately to prescribe the bloodB. Tell her that you will not authorize a transfusion simply to avoid

wasteC. Tell her she should not have removed the blood unnecessarily and

compete a clinical incident form after your shiftD. Encourage her to put the back back in the refrigerator so it can be

returned to the blood bank and used by other patientsE. Explain that transfusion carries significant risks and there is no

benefit in transfusing a non-anaemic patient

You are on call and bleeped by a ward nurse about a bag of blood which was mistakenly taken out of the fridge. As it cannot now be returned, she asks you to prescribe it for the patient so that is is not ‘wasted’. You are not intending to visit the ward for some time and the nurse sounds frustrated as the blood will be lost 30 mins after removal from the refrigerator.Rank in order of appropriate responses

A. Go to the ward immediately to prescribe the bloodB. Tell her that you will not authorize a transfusion simply to avoid

wasteC. Tell her she should not have removed the blood unnecessarily and

compete a clinical incident form after your shiftD. Encourage her to put the back back in the refrigerator so it can be

returned to the blood bank and used by other patientsE. Explain that transfusion carries significant risks and there is no

benefit in transfusing a non-anaemic patient

E, B, C, A, D

Effective communication

• Communicate concisely and clearly (verbally and written)

• Vary communication style appropriately• Able to negotiate• Willing to engage others in open dialogue

You are working as the medical FY1 when you are called to review a patient who has fallen. You stabilize the patient with ABCDE-directed management and complete a brief focused history and examination. You then make a telephone call to your registrar after planning first in your mind which details should be relayed.Rank in order the most appropriate actions

A. May I speak with you about an 80-year-old patient, admitted with falls, who has fallen again this evening?

B. The patient ins now in AF, and I think that this may have contributed to her fall. Her past medical history is significant for stroke

C. My plan is to arrange an X-ray of her right hip and then speak to you about managing her new AF. What should I do next?

D. Hello I am the medical FY1 on callE. I have informed the consultant at home

You are working as the medical FY1 when you are called to review a patient who has fallen. You stabilize the patient with ABCDE-directed management and complete a brief focused history and examination. You then make a telephone call to your registrar after planning first in your mind which details should be relayed.Rank in order the most appropriate actions

A. May I speak with you about an 80-year-old patient, admitted with falls, who has fallen again this evening?

B. The patient ins now in AF, and I think that this may have contributed to her fall. Her past medical history is significant for stroke

C. My plan is to arrange an X-ray of her right hip and then speak to you about managing her new AF. What should I do next?

D. Hello I am the medical FY1 on callE. I have informed the consultant at home

D, A, B, C, E

Patient focus

• Always show respect to patient• Adopt collaborative approach to decision-

making with patients• Maintain courtesy, empathy and compassion

at all times

Flora is 73 and suffering from hospital-acquired pneumonia. She has been receiving intravenous antibiotics, but is no longer confused and is becoming unhappy with your continued attempts at cannulation.Choose 3 most appropriate actions to take in this situation

A. Tell Flora she will probably die without intravenous antibioticsB. Stop the antibiotics and re-site the cannula if Flora deteriorates

without themC. Prescribe oral antibiotics and document clearly that Flora refused

cannulationD. Offer to ask a colleague to try if the next attempt failsE. Explain carefully why a cannula is necessaryF. Tell Flora that the next attempt will be successfulG. Persist with cannulation attempts as Flora does not have capacityH. Consider whether antibiotics can be de-escalated to oral

equivalents

Flora is 73 and suffering from hospital-acquired pneumonia. She has been receiving intravenous antibiotics, but is no longer confused and is becoming unhappy with your continued attempts at cannulation.Choose 3 most appropriate actions to take in this situation

A. Tell Flora she will probably die without intravenous antibioticsB. Stop the antibiotics and re-site the cannula if Flora deteriorates

without themC. Prescribe oral antibiotics and document clearly that Flora refused

cannulationD. Offer to ask a colleague to try if the next attempt failsE. Explain carefully why a cannula is necessaryF. Tell Flora that the next attempt will be successfulG. Persist with cannulation attempts as Flora does not have capacityH. Consider whether antibiotics can be de-escalated to oral

equivalents

D, E, H

Working effectively as part of a team

• Work in partnership while respecting different views

• Share tasks fairly• Ask for advice from others when necessary

Each time you phone radiology, you receive a barrage of criticism form a particularly discourteous radiology registrar. Your colleagues now try to make fewer requests whenever this particular registrar is on duty. He once criticized your ‘incoherent’ radiology requests and when you asked how your requests could be improved, he hung up the phone.Rank the responses in the most appropriate order

A. Arrange a meeting between the radiology registrar and the Mess President

B. Raise the issue with your Clinical SupervisorC. Ask for a slot in the monthly radiology meeting to discuss

communication between junior doctors and duty registrarsD. Contact the Clinical Director for Radiology to explain your difficultyE. Avoid making radiology requests when this registrar is on duty

unless they are absolutely necessary

Each time you phone radiology, you receive a barrage of criticism form a particularly discourteous radiology registrar. Your colleagues now try to make fewer requests whenever this particular registrar is on duty. He once criticized your ‘incoherent’ radiology requests and when you asked how your requests could be improved, he hung up the phone.Rank the responses in the most appropriate order

A. Arrange a meeting between the radiology registrar and the Mess President

B. Raise the issue with your Clinical SupervisorC. Ask for a slot in the monthly radiology meeting to discuss

communication between junior doctors and duty registrarsD. Contact the Clinical Director for Radiology to explain your difficultyE. Avoid making radiology requests when this registrar is on duty

unless they are absolutely necessary

B, D, C, E, A

Universal truths

• It is usually a good idea to seek senior advice• Rarely good to devolve responsibility to

nursing staff • Rarely good idea to directly contact medical

director about anything!• Never leave your job until there is someone to

take over from you…• Patient safety always takes precedence

What if you are stuck?

• Choose best and worst answers first and then think about those in between

• Don’t spend too long on the question – move on after a couple of minutes – come back later

• Systematically consider the consequences of each choice for (i) the patient, (ii) your colleagues and (iii) yourself

Top 10 tips for the SJT (BMJ)1 Read through the Good Medical Practice booklet 2 Make sure you are familiar with the competencies in the national person

specification3 Read each scenario twice, highlighting any key words as you go4 Look at all the options before assigning any rankings5 Remember you are not being asked to judge if an option is right or wrong6 Use only the information provided in the question – do not make

assumptions7 Lookout for paired or contradictory statements8 Make sure your choices make sense when taken together9 Keep an eye on the clock – don’t spend too long on any one question10 Double-check you have marked/circled the correct options – transcription

errors are a silly way to lose marks!

Your best weapon

Further tips

1. 3 from 8 questions (second section) are generally more straight forward.

2. Do not leave transcription of answers to the end – people have lost all marks in frameshift errors in the past!

3. Remember if you are stuck– Consequence for patient– Consequence for colleagues– Consequence for self IN THAT ORDER!